美沙酮维持治疗对男性海洛因依赖者决策倾向的影响

The effect of methadone maintenance treatment on decision-making biases in male heroin dependent patients

目的 探讨参加美沙酮维持治疗（MMT）男性海洛因依赖患者的风险决策认知能力.方法 将45例参加MMT的男性患者及与其人口学资料相匹配的32例健康对照组（HC）作为研究对象,采用爱荷华博弈任务（IGT）进行风险决策行为能力的测试.结果 排除焦虑、抑郁情绪及尿液吗啡检测阳性情况下,MMT组在IGT中净不利选牌数明显高于HC组[分别为（9.11±19.60）次,（-4.25±10.27）次],差异有统计学意义[t=3.884,P＜0.01].采用2（组）×5（阶段）方差分析比较2组不同阶段的净不利选牌数,发现2组间的主效应显著（F=12.414,P=0.01）;不同阶段的主效应亦显著（F=6.871,P＜0.01）.MMT患者净不利选牌数与首次吸毒年龄呈负相关（r=-0.320,P＜0.05）.MMT剂量高低组间比较及MMT时间长短组间比较,均未发现存在决策功能差异.结论 男性海洛因依赖患者决策认知功能损伤可能是不可复性的,可能与前额叶腹内侧功能异常有关;MMT不会加重男性海洛因依赖者决策功能损伤.

Objective To investigate the characteristics of decision-making impairment in male patients with heroin dependence in methadone maintenance treatment（MMT）. Methods A total of 45 male patients in MMT were compared with matched 32 health controls on the Iowa Gambling Task. Results Participants with anxiety or depression had to be excluded, MMT subjects were required to have negative urine toxicology screening tests.The MMT group selected more net disadvantageous cards （number of cards selected from the disadvantageous decks minus number of cards selected from advantageous decks） than health controls（ （9.11 ± 19.60, -4.25 ±10.27 respectively）, t=3. 884, P〈0.01）. A 2（group） ×5（block） ANOVA （analysis of variance） on the cards of net disadvantageous from the gambling task revealed a significant main effect of group（ F= 12.414, P〈0.01 ）.The ANOVA also revealed a significant main effect of block（ F=6.871, P〈0.01 ）. The study indicated the totalnumber of net disadvantageous cards for MMT subjects was negative correlation to the age of initial drug use （ r=- 0. 320, P 〈 0. 05 ）. Meanwhile, methadone dose and the time of enrollment MMT did not reveal a significant main effect on decision-making biases. Conclusion The deficit of decision making for male heroin dependent patients might be attributed to the dysfunction of the ventromedial prefrontal cortex, and this effect does not resolve with abstinence, even very long term abstinence. Methadone may not get worse this impairment in male patients who have a history of heroin use during maintenance treatment intervention.